[Technic of the intradermal Mantoux reaction. Tuberculin test].
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Evaluation Studies as Topic↗
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Different reactivity to recombinant Aspergillus fumigatus allergen I/a in patients with atopic dermatitis or allergic asthma sensitised to Aspergillus fumigatus.
We report a clinical study comparing the skin test reactivity to recombinant Aspergillus fumigatus allergen 1 (rAsp fI/a) in patients with atopic dermatitis and A. fumigatus sensitisation (n = 15), A. fumigatus-allergic patients with asthma (n = 10) and healthy control subjects (n = 10). All patients sensitised to A. fumigatus reacted at intradermal skin tests with commercial A. fumigatus extracts in contrast to the healthy subjects. Six out of 10 patients with well-characterised A. fumigatus allergic asthma were sensitised to rAsp fI/a as shown by a positive skin test. The patients with skin test reactivity to rAsp fI/a also showed rAsp f I/a-specific serum IgE as determined by ELISA. None of the patients with atopic dermatitis, healthy control subjects and 4 out of 10 A. fumigatus-allergic asthmatics reacted in intradermal tests to rAsp fI/a. Serologic investigations revealed that these subjects did not express detectable amounts of rAsp fI/a-specific IgE in agreement with the negative skin test results. Extended serologic investigations have not shown significant differences in rAsp fI/a-specific IgA, IgG4 and IgG1 serum levels between atopic dermatitis patients and healthy control subjects. The results suggest that sensitisation to A. fumigatus in patients with atopic dermatitis is not related to the major A. fumigatus allergen I in contrast to the high incidence of sensitisation to Asp fI/a occurring in allergic asthmatics.
Allergens↗
Insulin-induced drug eruptions and reliability of skin tests.
Allergic reaction to insulin preparations seemed to have decreased since the introduction of contaminant-free, human preparations. The role of protamine sulfate in decreasing the prevalence of allergy is unclear. This study examines the causative components of insulin allergy along with the value of skin tests for diagnosis. Eleven patients with insulin allergy and 53 patients receiving insulin but without an insulin allergy were included as controls. Intradermal skin tests were conducted using preparations containing various concentrations of insulin [Neutral protamine Hagedorn (NPH) insulin, regular insulin (RI)] and protamine sulfate. Of the 11 patients studied, 3 had anaphylaxis and 8 displayed localized reactions. All of the patients reacted positively during skin testing. Five patients showed positive intradermal skin test reactions to protamine sulfate, and 4 reacted to insulin. Two patients that were not tested with protamine sulfate reacted positively to NPH insulin. In the case of protamine sulfate, 4 patients with localized symptoms displayed positive reactions at concentrations of 10 microg/ml, 3 microg/ml or 0.3 microg/ml. One patient with anaphylaxis reacted positively to a concentration as low as 0.03 ng/ml. In the case of insulin protein, 3 patients reacted positively to a 100-fold dilution (1 UI/ml). Eight of the 53 controls experienced pruritus and/or skin lesions. However, none of the controls reacted at a concentration of NPH insulin of less than 10 U/ml or to protamine sulfate at less than 30 microg/ml. Allergic reactions to protamine sulfate are common and should not be ignored. This study shows a good correlation between clinical manifestations and skin test reactions for insulin allergy.
Adult↗
Evaluation of the gamma-interferon assay for eradication of tuberculosis in a goat herd.
OBJECTIVE: To evaluate the usefulness of the gamma-interferon assay in the diagnosis of caprine tuberculosis in comparison with a single intradermal tuberculin test, and to obtain a group of animals free from this infection in a herd with a high prevalence. DESIGN: An immunological study involving four serial comparative gamma-interferon and single intradermal tuberculin tests. ANIMALS: A herd of 87 goats of Guadarrama breed. PROCEDURE: Serial testing and segregation of animals. RESULTS: We found that the number of infections detected by the gamma-interferon test was considerably greater than the number detected by the single intradermal tuberculin test. A group of 10 animals was negative to both tests in two consecutive rounds and three kids were negative in the last round of testing. CONCLUSIONS: Gamma-interferon assay is appropriate for diagnosis and eradication of tuberculosis in goats. This test is able to detect early Mycobacterium bovis infection. Avian reactors with simultaneous increased reaction to bovine PPD in the gamma-interferon assay (designated as avian reactors) should be considered test positive for M bovis. By serial testing with the gamma-interferon and the single intradermal tuberculin tests, and a policy of segregation of kids at birth, it is possible to achieve a group of animals test negative for tuberculosis from a herd of goats with high immunoreactivity to this infection.
Animals↗
[Ventilatory function and allergic skin tests in cotton mill workers].
Ventilatory capacity, chronic respiratory symptoms and respiratory diseases as well as intradermal skin tests were registered in a group of 112 cotton workers. The prevalence of chronic respiratory symptoms and respiratory diseases was higher among the exposed than among control workers although the differences were statistically significant only for chronic cough, nasal catarrh and byssinosis in women and for chronic cough, chronic phlegm and byssinosis in men. A similar prevalence of byssinosis was noted in women (29.4%) and in men (29.5%). Among textile workers mostly byssinosis grade 1/2 was found (women 22.1%, men 20.5%). There were statistically significant acute reductions over work shift for forced vital capacity (FVC) and one-second forced expiratory volume (FEV1). In men the values were somewhat lower than the expected normal values. A very small number of workers demonstrated positive intradermal skin tests to cotton allergen (exposed 8.2%, control 1.8%). Our data indicate that exposure to cotton dust may lead to the development of respiratory symptoms and diseases as well as to acute changes in ventilatory capacity but without an allergic reaction.
Dust↗
[Insulin allergy: background, diagnosis and treatment].
An allergic reaction develops in 2.4% of patients that use insulin. This ranges in severity from erythema and pruritus to life-threatening anaphylaxis. llergic reactions to insulin usually occur within a few hours after an injection and are usually due to a local or systemic type I IgE-mediated hypersensitivity reaction. Despite considerable research into the immunogenicity of insulin, this has not yet been clarified completely and allergic reactions to insulin still occur. A systematic diagnostic approach is essential for an adequate treatment plan. A blood test for anti-insulin antibodies and intradermal skin tests are of great importance. There are many options available for the treatment of insulin allergy and each patient must therefore be evaluated individually.
Anaphylaxis↗
A comparative study between interdermal tests with phytohemagglutinin and delayed hypersensitivity reactions elicited by tuberculin.
Intradermal (i.d.) tests with phytohemagglutinin (PHA) and tuberculin are used in clinical practice to evaluate the cell-mediated immunity. The biologic significance of the skin response to PHA, clinically evaluated by the extent of erythema and induration, was studied histologically after incorporation of tritiated thymidine. It was compared to tuberculin tests. The rate of recruitment and the respective amount of inflammatory cells varied between patients and in time. In PHA tests the inflammatory reaction occurred in two phases, the first one consisting in the predominance of polymorphonuclears, the second one being characterized by chemotactism of lymphoblasts many of which synthesized DNA. The "in vivo" reaction to PHA is therefore complex; the same clinical evaluation corresponds to markedly different stages and events in the biological reaction. The histological grading of the PHA test is therefore desirable in the evaluation of the cell-mediated immunity because only the blastic proliferation is of importance in its rating and not the edema and the accumulation of polymorphonuclears.
Chemotaxis, Leukocyte↗
[Evaluation of the CIS Allergen Screen I kit versus the Pharmacia Cap System and skin tests in the diagnosis of respiratory allergy].
This study has given evaluation of a new pneumallergen diagnostic test CIS Allergen Screen I in comparison with Pharmacia Cap System and intradermal skin test. Five allergens (Mite (DPT) D1, Mite (DF) D2, Cat E1, Dog E2, Orchard grass G3) have been studied with in vitro tests (CIS Allergen Screen I Cap System) and the results obtained gave on patient to patient comparison a sensitivity of 91%, a specificity of 100% and on allergen comparison a sensitivity of 84%, a specificity of 99% and an accuracy of 93%. Compared with intradermal skin test for two allergens (Mite (DT) D1 and Orchard grass G3), CIS Allergen Screen I have good results to G3 but less specificity and sensitivity to D1. These results could be to depend on different standardisation between allergen extracts especially for Mite.
Allergens↗
Induction and modulation of the immune response to Leishmania by Montenegro's skin test.
The intradermal inoculation in naive or in previously sensitized individuals of small amounts of Leishmania extract (Montenegro's skin test) induced or modulated, respectively, the immune response to Leishmania, as assessed by subsequent Montenegro's skin tests. These phenomena could hinder the interpretation of Montenegro's skin tests in a population already subjected to the test in the past and, in addition, could affect in an unknown way the development of mucosal lesions in people infected with L. braziliensis or L. amazonensis, since those lesions have been associated with hypersensitivity to Leishmania antigens. Anti-Leishmania antibody responses, assessed by enzyme-linked immunosorbent assay, were not induced in naive individuals by Montenegro's skin tests, but tended to become more intense following these tests in previously sensitized individuals.
Animals↗
Anacardium occidentale (cashew) pollen allergy in patients with allergic bronchial asthma.
BACKGROUND: The cashew tree grows in abundance in the hills and plains of Goa, India. Because of the financial yield, more and more trees are being planted each year. The cashew tree flowers once a year between January and March, but pollination is mostly entomophilous. OBJECTIVE: For the first time, a study was conducted to establish the possible role of the cashew pollen in triggering allergic asthma. METHODS: A stock solution of pollen extract was prepared with the standard weight/volume method for intradermal skin tests and a bronchial provocation tests (BPTs). The protein content of the antigen, estimated with the use of Folin phenol reagent and a spectrophotometer, was 28.72 mg/ml. Ten healthy volunteers and 65 subjects with allergic asthma, as documented by previous positive skin test reactions to various pollens, were studied. RESULTS: Of the 65 patients, 26 (40%) had positive skin test reactions in various grades. BPTs were performed in 22 of the 26 patients after their baseline peak expiratory flow volume was assessed. Twenty (90.9%) patients had a positive BPT result, and the majority of patients had grade III and grade IV reactions. None of the control subjects (n = 10) had positive responses to either intradermal tests or the BPT. Serum IgE levels, estimated by ELISA, were high in patients with positive skin test responses and showed a linear correlation with cutaneous sensitivity. Control subjects showed normal levels of IgE (39.0 +/- 7.87 IU/ml). CONCLUSIONS: This study provided us with knowledge of an additional pollen, Anacardium occidentale, which could trigger an asthmatic response in allergic individuals.
Adolescent↗
Reactivity to intradermal injections of extracts of house dust and housedust mite in healthy dogs and dogs suspected of being atopic.
Fifty dogs underwent intradermal allergy testing with housedust mite and house dust extracts, using concentrations recommended by the manufacturer. Twelve dogs (group I) were healthy dogs obtained from a pound; 12 dogs (group II) were healthy, privately owned dogs; 15 dogs (group III) were suspected of being atopic and had had multiple positive reactions to intradermal injections of allergens of specific trees, weeds, grasses, or molds; and 11 dogs (group IV) were suspected of being atopic, but only had had positive reactions to intradermal injections of housedust mite, house dust, and flea antigen extracts. Use of the concentrations of housedust mite and house dust extracts currently recommended for intradermal allergy testing resulted in false-positive reactions in 14 of 24 (58%) and 12 of 24 (50%) healthy dogs tested, respectively. Differences in number of dogs with positive reactions or grade of reaction to housedust mite or house dust allergens were not detected between groups of healthy dogs (groups I vs II), between groups of suspected atopic dogs (groups III vs IV), or between healthy dogs and dogs suspected of being atopic (groups I and II vs III and IV). Therefore, clinical importance of positive results of intradermal allergy testing of house dust or housedust mite allergens was equivocal for dogs suspected of being atopic. Threshold concentrations for intradermal allergy testing were determined in 24 healthy dogs (group I and II) by intradermal administration of 5 dilutions each of housedust mite extract and house dust extract.(ABSTRACT TRUNCATED AT 250 WORDS)
Allergens↗
[Epidemiological survey on paragonimiasis in Kang Hwa Gun]
This study was undertaken to evaluate the status of human paragonimiasis in Kang Hwa Gun, Kyunggi Do, Korea from March 1973 to October 1975 by the use of intradermal screening test with Veronal buffered saline antigen. A total number of 7,352 (male 3,936; female 3,4l6) consisting of 3,447 primary school children, 2,689 middle school students, l,008 high school students of 9 Myuns out of 13 Myuns of this County and 208 residents of all age group in Kilgeong-Ri, Yangdo Myun were examined by the intradermal test with Paragonimus antigen. In order to detect Paragonimus egg, the sputum and the stool examinations were undertaken on the residents in Kilgeong-Ri. The infestation rate of crayfish with Paragonimus metacercaria was also examined in Konneung and Jeongha village in Kilgeong-Ri. The following results were obtained in this survey: 1. As a whole, 16.6 % of the examiners showed positive reaction with sexual difference of 16.1% in male and 14.8 % in female. 2. In age groups, the highest positive rate showed in middle school age group (17.1 %) than primary school (14.0 %) and high school age group (11.4 %). 3. In regional differences of positive rates, the highest rate (28.4 %) showed at Yangdo Myun followed by Kilsang Myun (27.0 %), Hwado Myun (25.0 %), and Naega Myun(20.8 %). 4. In the result of 208 residents Kilgeong-Ri, the positive of 36.1 % in male and 20.2 % in female. The highest positive rate showed in 10 to 19 age group (41.5 %). 5. Among the residents in Kilgeong-Ri, Paragonimus eggs were detected in 11 residents by the sputum and the stool examinations. 6. The infestation rate of crayfsh with Paragonimus metacercariae was 100 % (41 out of 41 crayfishes) in Konneung village, and 84.6 % (9 out of 13 crayfishes) in Jeongha village, Kilgeong-Ri. 7. The fluctuation of the infection rate of crayfish with Paragonimus metacercariae was decreased in Konneung village in 2 years after the treatment with Bilevon against 10 paragonimiasis patients.
Journal Article↗
Anaphylaxis to omeprazole: diagnosis and desensitization protocol.
BACKGROUND: Omeprazole is an inhibitor of the parietal cell enzyme H+/K+ adenosine triphosphatase. Immediate-type hypersensitivity reactions, such as urticaria, angioedema, and hypotension, induced by omeprazole and other proton pump inhibitors are rare. OBJECTIVES: To confirm the immediate-type mechanism of recurrent anaphylactic reactions to the repeated administration of omeprazole using skin testing and to enable safe administration of the drug after successful oral desensitization. METHODS: Intradermal skin tests were performed with omeprazole (0.04 and 0.4 mg/mL) prepared from the oral and intravenous commercial preparations and with pantoprazole (0.02 and 0.2 mg/mL) prepared from the oral commercial preparation. Skin tests were repeated after completion of the desensitization. Oral desensitization was applied at a starting dose of 0.001 mg of omeprazole, and a full dose of 16 mg was achieved after 5.6 hours (cumulative dose of 32.6 mg). RESULTS: Intradermal skin test results were positive to omeprazole and pantoprazole at all tested concentrations. After successful desensitization, omeprazole was administered in the full dose uneventfully. The wheal size of the intradermal skin tests performed after completion of the desensitization was significantly reduced. CONCLUSION: When indicated, this newly designed desensitization protocol may be used in patients with omeprazole-induced anaphylaxis.
Adult↗
Evaluation of a point-of-care immunodot assay for predicting results of allergen-specific intradermal and immunoglobulin E serological tests.
Immunotherapy to prevent recurrence of clinical signs of atopic dermatitis (AD) is based on intradermal or serological tests that assist in identifying allergen-specific immunoglobulin E hypersensitivities. Unfortunately, the results of such tests can be negatively influenced by several factors, which include the age of the patients, the season of testing and the administration of anti-allergic drugs. Screening to predict when these expensive tests will be useful would benefit owners of dogs with AD. The objectives of this study were to determine whether a point-of-care allergen-specific immunodot assay (Allercept E-Screen, Heska Corp., Ft Collins, CO, USA) could predict results of either intradermal or Allercept full panel serological tests in atopic dogs. Thirty dogs living in the south-eastern USA were diagnosed with AD in accordance with current standards. Allergen-specific intradermal, serological and E-Screen tests were performed in all subjects. For flea, house dust mite and pollen allergens altogether, results of the E-Screen assay agreed with those of intradermal and serological tests in 26/30 dogs (87%) and 25/30 dogs (83%), respectively. In this group of dogs, the probabilities of obtaining intradermal or serological tests positive for these allergens were 70 and 67%, respectively. If either skin or serum tests were performed only in dogs with positive E-Screen tests, the probability of obtaining positive results would be increased from 70 to 95% and from 67 to 90%, respectively. In this population of dogs with AD, results of the E-Screen point-of-care immunodot assay was found to often agree with those of allergen-specific intradermal or Allercept tests for selected allergen groups.
Allergens↗
The effects of montelukast on intradermal wheal and flare.
OBJECTIVE: We sought to determine the effect of montelukast, a leukotriene receptor antagonist, on intradermal skin testing. Study design and setting We conducted a prospective, randomized, double-blind, placebo-controlled study in a university setting. METHODS: After a 1-week washout of allergy pharmacotherapy, intradermal skin testing was performed on 23 atopic subjects. Whealing size was measured 20 minutes after injection. Subjects then began a 1-week regimen of daily loratadine, montelukast, or placebo. At 1 week, subjects again underwent intradermal skin testing. The change in wheal size was then calculated from baseline. RESULTS: A significant difference (P < 0.05) between the montelukast and loratadine groups in suppression of intradermal whealing at 1 week was observed. No significant difference was noted between the montelukast and placebo subjects. CONCLUSIONS: Montelukast demonstrated no significant suppression of skin whealing after antigen challenge over placebo. SIGNIFICANCE: Montelukast does not need to be discontinued before intradermal allergy testing.
Acetates↗
A rational clinical approach to suspected insulin allergy: status after five years and 22 cases.
AIMS: Allergy to recombinant human (rDNA) insulin preparations is a rare complication of insulin therapy. However, insulin preparations contain several allergens, and several disorders can resemble insulin allergy. Studies evaluating the diagnostic procedures on suspected insulin allergy are extremely few. METHODS: Since January 1998, we have used a standardized investigative procedure during admittance to the medical ward allowing observation and repeated recording of reactions to intradermal skin test (performed with a commercially available kit containing isolated insulin allergens). Data on all investigated cases until April 2003 were collected retrospectively, and self-reported efficacy of intervention was compared to clinical data. RESULTS: Twenty-two patients were included. In nine (41%) cases, non-insulin allergic causes were discovered and successfully treated: poor injection technique (n = 5), skin disease (n = 3) and other systemic allergy (n = 1). Nine other patients were found to be allergic to protamine (n = 3) or rDNA insulin (n = 6), and specific treatment was associated with relief in 8 patients (89%). Four patients had local reactions of unknown causes but symptom relief was obtained in three cases by unspecific therapy. Overall, 20 (91%) reported relief of symptoms. CONCLUSION: Our standardized investigative procedure of suspected insulin preparation (IP) allergy was associated with relief of symptoms in > 90% of patients. IP allergy was diagnosed in 41%, and intradermal testing with isolated insulin allergens was a prerequisite in identification of culprit allergen and targeting of treatment.
Adult↗
Patch testing to detect corticosteroid allergy: is it adequate?
Whilst patch testing with corticosteroids in ethanol is more sensitive than either petrolatum or the cream formulation, the frequency of false-negative reactions is not known. We have compared patch testing with corticosteroid at 1% in ethanol with intradermal (i.d.) tests using 1 mg corticosteroid suspended in normal saline. Patch tests with tixocortol pivalate and budesonide detected all patients allergic to hydrocortisone and budesonide, respectively. For other corticosteroids, the use of ethanol as a vehicle resulted in both false-positive and false-negative reactions. In particular, patch tests with hydrocortisone-17-butyrate missed 30% of all positive reactions detected by i.d. testing. There may be a case for advising the avoidance of this steroid in all patients who are positive on patch testing to tixocortol pivalate and budesonide.
Anti-Inflammatory Agents↗
Mapping of T cell epitopes of the major fraction of rye grass using peripheral blood mononuclear cells from atopics and non-atopics. II. Isoallergen clone 5A of Lolium perenne group I (Lol p I).
Rye grass is the major cause of hay fever which currently affects 20% of the population. Lolium perenne group I (Lol p I) is a glycoprotein of 240 amino acid residues, representing the main allergen of rye grass. We have used peripheral blood mononuclear cells (PBMC) from controls and subjects allergic to rye grass and cultured them with L. perenne extract (LPE) and Lol p I and measured lymphocyte activation using thymidine incorporation. Patients were further studied against the 115 overlapping peptides of the iso-allergen clone 5A of Lol p I to see whether the 4 amino acid residue differences between clone 1A and clone 5A affect the T cell epitope and thus, lymphocyte activation. There are 24 peptide differences between isoallergen clone 1A and clone 5A occurring in pools 4, 13, 16 and 19 each one of which could be an immunodominant epitope. The PBMC from all allergic patients studied showed a strong proliferative response to LPE and Lol p I. Five immunogenic peptide pools, pool 6, 15, 16, 17 and 19 of the isoallergen clone 5A were also identified. Most of these pools are in the C-terminal region of Lol p I. Out of 20 pools tested in vitro 1 pool (pool-17) induced PBMC proliferation in five out of six patients who were not restricted to an HLA class II DR gene product. However, three out of the six subjects responded to various other peptide pools in addition to the immunodominant pool. In spite of the amino acid differences between the two clones, pool 17 still remains the immunodominant T cell epitope. Control subjects showed only weak responses to LPE and no detectable response to either Lol p I or peptide pools. From within the most active pool we have defined two peptides of the isoallergen clone 5A (identical in sequence with clone 1A) which stimulate lymphocytes from rye grass-sensitive patients in vitro. Previous studies with the two continuous sequences (193WGAVWRIDTPDK204 and 195AVWRIDTPDKLT206) tested in vivo by intradermal skin testing have shown typical delayed-type hypersensitivity reactions after 24-48 h in one patient. Comparison of amino acid sequences of Lol p I, Lol p II and Lol p III proteins revealed a significant level of structural similarity among them. Interestingly, 50% of the residues of the second peptide sequence are also present in Lol p II and Lol p III.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗